What Is Anorexia Nervosa?
Anorexia Nervosa is an eating disorder characterised by the deliberate refusal to eat enough to maintain a normal body weight. As a result, both the body and the mind are starved of the nutrients needed for healthy, balanced functioning. Though anorexia is a serious illness which can be fatal, full recovery is possible with appropriate support and treatment.
Although the word ‘anorexia’ literally means loss of appetite, this does not accurately describe what a person experiences. Appetite is suppressed rather than lost and an intense interest in food is retained. Self-starvation and weight loss/control represent an attempt to feel more in control of one’s life and gives the person a much needed sense of effectiveness and achievement. Restriction of food intake often begins with the gradual elimination of high calorie foods from the diet. A sudden preference for a vegetarian diet may form part of the pattern. At first, this can resemble a normal diet or lifestyle choice but the relentless drive behind the behaviour becomes more and more obvious as the disorder progresses. Other means of maintaining low body weight might include fasting, excessive exercise, self-induced vomiting, the use of laxatives, diuretics or appetite suppressants.
Anorexia nervosa can affect both males and females of all ages. It is most common amongst girls and young women. Around 10% of people with anorexia are male (see Eating Disorders in Men). Many factors combine to make any one person more vulnerable to anorexia than another and these factors vary from person to person. Anorexia is not primarily about food and weight issues or about ‘slimming’. As with all eating disorders, the psychological issues and emotional distress underlying the physical symptoms must be addressed for long-term recovery to be possible.
- Restriction of food intake.
- Intense fear of putting on weight. This fear is not lessened by weight loss.
- Preoccupation with body weight, size and shape. Self-evaluation and self-esteem become increasingly linked to these.
- Perception of body shape and size are disturbed (body image distortion). Even an obviously emaciated body is experienced as fat.
- Disruption of hormonal balance. In women and adolescent girls the menstrual cycle is upset: periods become irregular and eventually cease (amenorrhoea). In men there can be a loss of libido. In pre-pubertal children growth can be disrupted and sexual development can be delayed.
Other Signs & Symptoms
Physical signs and symptoms:
- Over-activity and excessive exercising.
- Increased sensitivity to cold.
- Poor circulation.
- Bloating of stomach, fluid retention.
- Constipation and abdominal pain.
- Restlessness, inability to settle.
- Difficulty sleeping, tiredness.
- Dry, thinning hair.
- Dry, discoloured skin.
- Growth of fine, downy hair (lanugo) on the face and body resulting from the body’s efforts to keep warm.
- Loss of periods.
- Decreased interest in sex.
Psychological and social signs and symptoms:
- Low self-esteem.
- Irritability and mood swings.
- Difficulty resolving conflict.
- Social isolation.
- Difficulty coping with change and frustration.
- Inflexible ‘black or white’/ ‘right or wrong’ thinking.
- Obsessive and/or compulsive behaviour.
Food related signs and symptoms:
- Rigid, limited diet.
- Frequent weighing.
- Excessive thinking and talking about food and related issues.
- Lying about food intake, claiming to have already eaten or to have plans to eat elsewhere.
- Chasing food around the plate, taking a long time over meals.
- Cooking for others.
- Reading and collecting recipes.
- Rituals around food and eating.
- Increased use of spices, condiments, chewing gum.
- Increased consumption of fluids.
- Episodes of bingeing or perceived overeating.
- Secret disposal of food.
Most symptoms will reverse with weight gain and normalisation of diet and eating habits.
Health Consequences of Anorexia Nervosa
In order to deal with the effects of starvation, the body is forced to slow down all its processes and to find ways of conserving energy. The physical effects of starvation include:
- Dehydration -> risk of kidney failure.
- Muscle weakness -> risk of muscle loss.
- Tiredness and overall weakness -> risk of fainting.
- Abnormally slow heart rate and low blood pressure produces changes in the heart muscle -> risk of heart failure.
- Loss of bone density resulting in dry, brittle bones (osteoporosis) -> risk of postural problems and risk of fracture.
Starvation also affects a person’s thinking and behaviour. Poor nutrition and dehydration produce changes in brain chemistry. It is thought that these changes in brain chemistry contribute to sustain the distorted thinking, disturbed perception and obsession with food associated with anorexia. Intellectual ability can also be affected resulting in reduced concentration, poor memory, difficulties with abstract thinking, problem solving, decision making and planning. In some cases, these changes can also increase vulnerability to depression, anxiety and other psychiatric disorders such as obsessive-compulsive disorder. If the depression is severe, there is a risk of suicide.
Other means of weight control such as self-induced vomiting, use of laxatives or diuretics and excessive exercise can also have very serious health consequences and can have a significant impact on a person’s capacity to function effectively.
Most anorexics have ‘rules’ that they have put in place, like the amount of calories they are ‘allowed’ in a day, what foods to avoid and how much to have. Some anorexics purge to remove food that they have eaten or take laxatives to speed up the digestion processor take up excessive exercise to be slimmer. All of these methods are dangerous as they can cause electrolyte imbalance and heart arrhythmia.
Anorexia often becomes a way of coping with life and demonstrating control of body weight and shape. However, ultimately the disorder itself becomes overwhelming, taking control, causing chemical changes in the body and affecting the brain. This causes distorted thinking and makes it almost impossible for the sufferer to make rational decisions.